This is my first post on this forum after joining in 2020. I have had a strange journey to get here, but I’m so glad to have found you all. It’s been a long journey to get here so I do hope you all can help. So as not to go on too much, I’ve updated my bio for a little back story.
52 year old female, menopausal, 83kg ( and gaining).
50ug vitamin D daily & Berrocca
Currently not gluten free
Diagnosed Autoimmune Thyroiditis August 2020
I requested a dose increase of 25 micrograms of Levothyroxine in June from my GP but he refused saying my results were in range and I’m sub-clinical hypothyroid. I still feel dreadful. I’ve recited NICE guidelines of TSH to be 1 or below, dosage guidelines of 1.6 micrograms per kilogram of body weight, my mother is Hypothyroid & my Sister has Thyroid Cancer & had her thyroid removed in 2020 .
So, my question is…… what do I do need & how do I go about getting it? Do I write to my GP OR ask to see an endo either private or NHS. I’ve battled my way here but I’m a bit lost as to what I need, any help would be much appreciated. Thanks
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lewis4269
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So it seems that you already know that generally most hypo patients feel better when TSH is 1 or below with FT4 and FT3 in the upper part of their ranges.
Your results obviously show that you need an increase in your dose but your GP is not taking any notice of the evidence that you have presented him with. To say you are "sub-clinical hypothyroid" is ridiculous, you have a diagnosis of hypothyroidism (autoimmune thyroid disease aka Hashimoto's as shown by your raised antibodies) and are on Levo so there's nothing sub clinical about it!
So, how do you go about getting the increase that you need? First of all, is there another GP in the surgery that you can see? Even if you asked for a referral to an NHS endo you are very likely to be refused by the endo because your results are in range. It might be worth seeing a private one and you can send for the list of thyroid friendly edos (both NHS and private) from ThyroidUK by emailing:
tukadmin@thyroiduk.org
If you decide to do that then please do your own research on any endo that you are considering to make sure they are right for you, you can ask for feedback on any here on the forum but as we can't discuss them openly replies must be by private message.
As for your nutrient results:
Ferritin 44.7ug/L (13 -150)
This is very low and needs to be improved. Some experts say the optimal level for thyroid function is 90-110ug/L and improving your level may mean that your thyroid hormone works better.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
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Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
You could ask your GP to do an iron panel but likely to be refused, in which case Medichecks to a Home Iron Panel which includes serum iron, transferrin saturation percentage, total iron binding capacity and ferritin, plus CRP.
Folate 10.03ug/L >3.89
This isn't too bad, Medichecks range is 3.89-19.45 and folate is recommended to be at least half way through range, so that would be about 12 plus with that range.
B12 124pmol/L (37.5 - 150)
This is a good result for Active B12.
Vit D 102nmol/L (50-200)
50ug D3 = 2,000iu and you may need more during the winter. The Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommending at east 125nmol/L.
Do you take D3's important cofactors - magnesium and Vit K2-MK7?
As for Berocca, it's not easy to find out exactly what they include and they make several versions. The ingredient list I can find on Amazon isn't very helpful and makes me think they use the wrong form of active ingredients and as a multivitamin it's not recommended for several reasons, one of which is that certain ones shouldn't be taken together.
So if yours is anything like this
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then:
Folic acid is the wrong form, methylfolate is the recommended form
B12 is bound to be the cheapest cyanocobalamin form and methylcobalamin is the recommended form
Calcium shouldn't be supplemented unless tested and found to be deficient
Magesium doesn't say which form but could be oxide which is the cheapest and east absorbable and tends to be used for constipation
Zinc - we have to be careful here - zinc and copper should be balanced and we hypos tend to have one high and the other low, so we don't know if or which should be supplemented unless we test
It contains Vit C which should be taken 2 hours away from B12 as it can stop the body using the B12.
Calcium should not be taken at the same time as zinc or magnesium.
So really this supplement is not a lot of use. You would be better off supplementing with a separate B Complex (eg Thorne Basic B is a good one), separate Vit C, and separate magnesium as a cofactor of D3.
That’s why I need help, I had the fugures infront of me but somehow they got jumbled up🤷♀️. My grammar is usually a lot better also.FT3: 3.93 (3.1 - 6.8) =22.43%
FT4: 17.9 (12-22)= 59%
Blood tests taken as instructed.
I don’t take any D3’s.
So, Ditch the Berocca & get Thorne Basic B, Vit C & Magnesium.
50ug D3 = 2,000iu and you may need more during the winter.
and went on to tell you what the recommended level of Vit D is.
So, Ditch the Berocca & get Thorne Basic B, Vit C & Magnesium.
Yes.
In future leave the B Complex off for 3-7 days before any blood test as it contains biotin and this can give false results.
You also need to sort out the D3 and take it's important cofactors.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Thanks for the reply. Re: the doctors, we do have an older GP who is due to retire, my Doctor is newly trained & we have 3 locums. From your experience would you opt for an older GP who may have experienced many Thyroid patients or a Locum who probably won’t care too much? It’s becoming a family joke…. Trying to get a dose increase. I have to go into it this time with my sleeves rolled up😂
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Alternatively, go over GP head and see thyroid specialist endocrinologist privately
My Doctor is convinced I have Lupus so is pushing for a diagnosis on this. Dermatology & Rheumatology both say a lot of my symptoms are Hypothyroid. Needless to say nobody agrees with anybody else and I’m just left waiting.
I’m happy to see a private endocrinologist, at this point I’m just sitting my life away. Do I need a GP referral for that?
I am planning my route to a dose increase, do I innocently ask for dose increase with a “new “ doctor or do I do it in writing with my medichecks results? I wasn’t really expecting so much resistance from 75mg to 100mg.
I will make sure to use the word “trial”. I haven’t tried any other brands of Levothyroxine, my 50mg was Teva also. Would changing brands maybe help ? I do have a very gurgling stomach.
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Would someone please be able to help interpret results?
Advice on results please for a new member
Help on latest test results please
Blood test results - help please!!
